Name: a modified technique for arteriovenous fistula construction in rabbits
Uploaded: 2023-02-10T13:33:00
Description: Watch this Scientific Journal Video about A Modified Technique for Arteriovenous Fistula Construction in Rabbits at JoVE.com

本研究得到了苏州市科技计划项目（SYS2020077）、苏州高新区医疗卫生科技计划项目（2020z001）、苏州市科技发展计划项目-医疗健康科技创新项目（SYK2021030）、南京医科大学科技发展基金项目（NMUB20210253）、苏州市科技局基础研究应用项目的资助 （编号：SYSD2019205、编号：SYS2020119）、江苏省中医药科技发展计划项目（编号：MS2021098）、教育部产学合作办学项目（编号202102242003）、江苏省第六届“333高层次人才培养”项目、苏州市科技城医院2022年院级预研基金项目（SZKJCYY2022014）、苏州市“科教兴卫”青年科技项目 （KJXW2022086）.

使用实验动物的实验程序得到了南京医科大学实验动物福利伦理委员会的批准。本研究使用10个月大的新西兰兔子（男女;体重，3.18±0.24公斤）。这些动物是从商业来源获得的（见 材料表）。
1. 动物制备
<ol><li>将盐酸替他明和盐酸唑拉西泮（3mg/kg）混合静脉注射至耳边静脉，后肢肌肉肌内注射sumianxin II（0.02mL/kg）（见 材料表），麻醉兔...

<ol>
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F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sheep+model+of+hemodialysis+arteriovenous+fistula+using+superficial+veins.">Sheep model of hemodialysis arteriovenous fistula using superficial veins.</a> Seminars in Dialysis. 28 (6), 687-691 (2015).</li><li>Ramacciotti, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fistula+size+and+hemodynamics:+An+experimental+model+in+canine+femoral+arteriovenous+fistulas.">Fistula size and hemodynamics: An experimental model in canine femoral arteriovenous fistulas.</a> The Journal of Vascular Access. 8 (1), 33-43 (2008).</li><li>Eiketsu, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arterial+enlargement,+tortuosity,+and+intimal+thickening+in+response+to+sequential+exposure+to+high+and+low+wall+shear+stress.">Arterial enlargement, tortuosity, and intimal thickening in response to sequential exposure to high and low wall shear stress.</a> Journal of Vascular Surgery. 39 (3), 601-612 (2004).</li><li>Eddie, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+arteriovenous+fistula+model+to+study+the+development+of+neointimal+hyperplasia.">A new arteriovenous fistula model to study the development of neointimal hyperplasia.</a> Journal of Vascular Research. 49 (2), 123-131 (2012).</li><li>Karl, A. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+murine+dialysis+fistula+model+exhibits+a+senescence+phenotype:+pathobiological+mechanisms+and+therapeutic+potential.">The murine dialysis fistula model exhibits a senescence phenotype: pathobiological mechanisms and therapeutic potential.</a> American Journal of Physiology. Renal Physiology. 315 (5), 1493-1499 (2018).</li><li>Hong, S. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+analysis+of+radiocephalic+fistula+using+side-to-side+anastomosis+with+distal+cephalic+vein+ligation.">Clinical analysis of radiocephalic fistula using side-to-side anastomosis with distal cephalic vein ligation.</a> The Korean Journal of Thoracic and Cardiovascular Surgery. 46 (6), 439-443 (2013).</li><li>Tang, W. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+meta-analysis+of+traditional+and+functional+end-to-side+anastomosis+in+radiocephalic+fistula+for+dialysis+access.">A meta-analysis of traditional and functional end-to-side anastomosis in radiocephalic fistula for dialysis access.</a> International Urology and Nephrology. 53 (7), 1373-1382 (2021).</li><li>Marie, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patterns+of+blood+flow+as+a+predictor+of+maturation+of+arteriovenous+fistula+for+haemodialysis.">Patterns of blood flow as a predictor of maturation of arteriovenous fistula for haemodialysis.</a> The Journal of Vascular Access. 15 (3), 169-174 (2014).</li><li>Srivastava, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spiral+laminar+flow,+the+earliest+predictor+for+maturation+of+arteriovenous+fistula+for+hemodialysis+access.">Spiral laminar flow, the earliest predictor for maturation of arteriovenous fistula for hemodialysis access.</a> Indian Journal of Urology. 31 (3), 240-244 (2015).</li><li>Loveland-Jones, C. 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目前，有几种动物模型可用于AVF。其中，猪、羊、狗多用作大型动物模型13、14、15。使用的小动物模型包括兔子，大鼠和小鼠16，17，18。本研究使用了新西兰兔。新西兰兔在EJV周围有丰富的静脉周围组织，有利于MNTT方法的研究。使用新西兰兔的优点包括手?...

动静脉瘘 （AVF） 的构建在临床实践中广泛用于接受维持性血液透析 （MHD） 的患者，与动静脉移植 （AVG） 或隧道式囊导管 （TCC） 相比，它具有更高的通畅性和更少的并发症1，2。虽然AVF是血管通路的首选模式，但它并不完美，并且具有固有的局限性。1 年原发性 AVF 通畅率仅为 60%-65%，许多失败发生在近吻合口区域3，4，5。
在传统的手术方法中，血管会经历不同程度的损伤，最终影响AVF的成熟。新的手术方式，例如Hörer等人提出的非接触技术（NTT）（补充图1）6和Sadaghianloo等人提出的桡动脉移位和再植入术（RADAR）7，8和Bai等人9，旨在降低并列吻合口狭窄的发生率，并通过修改手术技术来改善瘘管通畅。虽然RADAR的效果优于NTT，但RADAR观察到流入动脉狭窄更为突出。为了进一步减少手术过程中对静脉和动脉的伤害，2021 年，提出了一种新的改进的无接触技术 （MNTT），通过保留头静脉周围的静脉组织而不切割桡动脉来创建放射性头颅 AVF（补充图 1 和补充图 2）。初步结果显示初级通畅性增加，吻合口狭窄减少，无动脉狭窄10，11。
考虑到目前缺乏使用MNTT的AVF动物模型，并进一步探索MNTT在AVF手术中的机制，本研究引入了使用MNTT的颈总动脉（CCA）-颈外静脉（EJV）AVF手术。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Animal Depilatory</td>
			<td>Fuzhou Feijing Biotechnology Co., Ltd.</td>
			<td>PH1877</td>
			<td></td>
		</tr>
		<tr>
			<td>Curved hemostatic forceps</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZH131R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Dissecting forceps</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZDO25R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>electrical razor</td>
			<td>Shenbao Technology Co., Ltd</td>
			<td>PGC-660</td>
			<td></td>
		</tr>
		<tr>
			<td>Fixed Table</td>
			<td>Zhenhua Biomedical Instrument Co., Ltd</td>
			<td>ZH-DSB019</td>
			<td></td>
		</tr>
		<tr>
			<td>Halsey needleholder</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZM208R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Heparin Dodium Injection</td>
			<td>Jiangsu Wanbang Biochemical Pharmaceutical Group Co., Ltd.</td>
			<td>H32020612</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical gauze dressing</td>
			<td>Nanchang Kangjie medical hygiene products Co., Ltd</td>
			<td>20172640135</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro forceops</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZD275RN/T</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro needle holder forceps</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF2618RB/T</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro scissors</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF022T</td>
			<td></td>
		</tr>
		<tr>
			<td>Non-silk sutures 4-0</td>
			<td>Kollsut Medical Instrument Co., Ltd.</td>
			<td>NMB020RRCN26C075-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Non-absorbable sutures 8-0 (double needle)</td>
			<td>Yangzhou Yuankang Medical Instrument Co., Ltd.</td>
			<td>10299023602</td>
			<td></td>
		</tr>
		<tr>
			<td>Povidone iodine solution</td>
			<td>Shanghai Likang Disinfection High-tech Co., Ltd.</td>
			<td>310512</td>
			<td></td>
		</tr>
		<tr>
			<td>Rinse needle</td>
			<td>Jiangsu Tonghui Medical Instrument Co., Ltd</td>
			<td>20180039</td>
			<td></td>
		</tr>
		<tr>
			<td>scalpel handle</td>
			<td>Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instruments Factory</td>
			<td>J11030</td>
			<td></td>
		</tr>
		<tr>
			<td>Sharp blade</td>
			<td>Suzhou Medical Products Factory Co., Ltd.</td>
			<td>TY21232001</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Chloride Injection&#160; (100 mL)</td>
			<td>Guangdong Otsuka Pharmaceutical Co., Ltd.</td>
			<td>B21K0904</td>
			<td></td>
		</tr>
		<tr>
			<td>Sugical Scissors</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZC120R/RN</td>
			<td></td>
		</tr>
		<tr>
			<td>Sumianxin II</td>
			<td>Jilin Dunhua Shengda Animal Pharmaceutical Co., Ltd.</td>
			<td>20180801</td>
			<td></td>
		</tr>
		<tr>
			<td>Syringe with needle&#65288;5 mL)</td>
			<td>BD medical devices (Shanghai) Co., Ltd</td>
			<td>2006116</td>
			<td></td>
		</tr>
		<tr>
			<td>Tiletamine Hydrochloride and Zolazepam Hydrochloride for Injection</td>
			<td>Virbac Pet Health, France</td>
			<td>83888204</td>
			<td></td>
		</tr>
		<tr>
			<td>Triangle needle</td>
			<td>Hangzhou Huawei medical supplies Co., Ltd</td>
			<td>7X17</td>
			<td></td>
		</tr>
		<tr>
			<td>Vascular clamp</td>
			<td>Xinhua Surgical Instrument Co., Ltd.</td>
			<td>ZF220RN</td>
			<td></td>
		</tr>
		<tr>
			<td>New Zealand rabbits</td>
			<td>Suzhou Huqiao Biological Co., Ltd.</td>
			<td>SCXK2020-0001</td>
			<td></td>
		</tr>
	</tbody>
</table>

a modified technique for arteriovenous fistula construction in rabbits

吻合口狭窄是一个具有挑战性的问题，通常会导致不成熟并降低动静脉瘘 （AVF） 的通畅性。手术过程中静脉和动脉损伤和血流动力学变化可导致内膜增生，导致并联吻合口狭窄。为了减少手术过程中对静脉和动脉的损伤，本研究提出了一种新的改进的AVF构建非接触技术（MNTT），可以降低并列吻合口狭窄的发生率并改善AVF通畅性。为了揭示MNTT的血流动力学变化和机制，本研究提出了使用该技术的AVF程序。尽管该程序在技术上具有挑战性，但经过充分培训后，程序成功率为94.4%。最终，34 只兔子中有 13 只在手术后 4 周出现了功能性 AVF，导致 38.2% 的 AVF 通畅率。然而，在4周时，生存率为86.1%。超声检查显示通过AVF吻合口的活跃血流。此外，在吻合口附近的静脉和动脉中观察到螺旋层流，表明该技术可以改善AVF的血流动力学。组织学观察显示，AVF吻合口处未见明显的静脉内膜增生，而吻合口近端颈外静脉（EJV）未观察到显著的内膜增生。该技术将提高对使用MNTT进行AVF构建的机制的理解，并为AVF构建中手术方法的进一步优化提供技术支持。

该技术成功应用的结果是兔颈中的专利AVF。本研究采用以下标准来评价成功与否：（1）血管吻合完成后，可触摸AVF静脉震颤，可闻血管杂音;（2）AVF建立4周后，可通过彩色多普勒超声测量通过内瘘吻合口的活性血流;（3）AVF建立4周后，苏木精-伊红（H&E）染色显示AVF吻合处有明显的静脉内膜增生。
这项研究总共包括36只健康的新西兰兔子。总共有 34 只兔子使用 MNTT 立即获得了...

Watch this Scientific Journal Video about A Modified Technique for Arteriovenous Fistula Construction in Rabbits at JoVE.com

A Modified Technique for Arteriovenous Fistula Construction in Rabbits

本议定书建议使用改进的非接触技术在兔子中创建动静脉瘘。该技术涉及颈总动脉和颈外静脉的左右吻合，而无需解剖静脉周围组织或切断动脉。

一种改良的兔动静脉瘘构建技术

Juxta-anastomotic stenosis is a challenging problem that often causes non-maturation and decreases the patency of an arteriovenous fistula (AVF). Injury ...

临床上，使用改进的非接触技术创建的放射性头型AVF可以增加初次通畅并减少并减少并肩吻合口狭窄。为了探索MNTT的机制，需要建立这种动物模型。改进的无接触技术的主要优点是在建立 AVF 时减少颈外静脉损伤。在处理颈外静脉时，应注意尽可能保留静脉旁组织并减少对静脉的损伤。首先，将麻醉的兔子仰卧放在固定的桌子上。绑住它的四肢和门牙。使用电动剃须刀剃掉兔子的脖子和上胸部，并用动物脱毛膏去除毛发。接下来，用剪刀在下颌骨和胸锁关节之间做一个三厘米长的切口。确定右侧颈外静脉或EJV，并使其垂直于其建立隧道。沿管放置血管夹，同样在远端 EJV 处再建一条管。通过沿隧道应用4-O缝合线和夹子来控制血流。要解剖颈总动脉，首先探索气管外侧和胸锁乳突肌内侧的 CCA。现在，剖析两厘米的CCA。使用4-0缝合线，在需要时控制血流。将血管钳夹放在 CCA 的远端和近端晶状体处。对于放血和吻合术，使用微型剪刀解剖 EJV 内部的 4 毫米。然后，在静脉中间做一个四毫米长的切口。用肝素溶液冲洗静脉以防止血栓形成。在动脉前壁做一个类似的切口，并如图所示冲洗。将 EJV 和 CCA 尽可能靠近。使用8-0应用康奈尔的技术不可吸收的缝合线，用于对血管进行并排吻合。首先缝合血管的后壁，然后缝合前血管壁。要观察通过吻合口的活跃血流，请取下除远端 EJV 处的血管夹。使用之前放置的 4-0 缝合线，结扎 EJV 的远端，然后取下远端夹具。取下CCA周围的缝合线。在34只使用改良的非接触技术立即成功治疗动脉静脉瘘的兔子中，只有31只兔存活下来，存活率为86.1%13只34只兔子在手术后四周内有功能性AVF，导致AVF通畅率为38.2%。动脉静脉瘘未闭在四周后得到证实。在吻合口附近的两个血管中观察到螺旋层流。HE染色后，在动静脉瘘吻合部位观察到明显的静脉内膜增生，但在吻合口的近端EJV未观察到。利用MNTT建立的AVF动物模型可为进一步探索并联吻合口狭窄的分子生物学机制提供技术支持。

Research

JoVE Journal

Medicine

Modified Technique for Coronary Artery Ligation in Mice

改性技术在小鼠冠状动脉结扎

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI ...

科研

医学

Technical Aspects of the Mouse Aortocaval Fistula

在的鼠标Aortocaval瘘的技术方面

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

Human Skeletal Muscle Biopsy Procedures Using the Modified Bergstr&#246;m Technique

Human Skeletal Muscle Biopsy Procedures Using the Modified BergstrÃƒÆ’Ã‚Â¶m Technique

人骨骼肌活检手术使用修改伯格斯坦技术

The percutaneous biopsy technique enables researchers and clinicians to collect skeletal muscle tissue samples. The technique is safe and highly ...

A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail

动静脉内瘘失败的新型小鼠模型：在详细介绍手术过程

The arteriovenous fistula (AVF) still suffers from a high number of failures caused by insufficient remodeling and intimal hyperplasia from which the ...

Intraluminal Drug Delivery to the Mouse Arteriovenous Fistula Endothelium

腔内药物输送到鼠标动静脉瘘内皮

Delivery of therapeutic agents to enhance arteriovenous fistula (AVF) maturation can be administered either via intraluminal or external routes. The ...

A Step by Step Protocol for Subretinal Surgery in Rabbits

一种用于兔视网膜下手术分步协议

Age related macular degeneration (AMD), retinitis pigmentosa, and other RPE related diseases are the most common causes for irreversible loss of vision in ...

Mouse Model for Pancreas Transplantation Using a Modified Cuff Technique

应用改良袖套技术的小鼠胰腺移植模型

Mouse models have several advantages in transplantation research, including easy handling, a variety of genetically well-defined strains, and the ...

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique

使用改进的非接触技术在前臂中创建放射性头动静脉瘘

Autologous arteriovenous fistula (AVF) is the primary and best option to obtain vascular access for hemodialysis treatment; other options are ...

Modified Technique for the Use of Neonatal Murine Hearts in the Langendorff Preparation

新生儿鼠心在朗根多夫制剂中的应用改良技术

The use of the ex-vivo retrograde perfused heart has long been a cornerstone of ischemia-reperfusion investigation since its development by Oskar ...

A Modified Cuff Technique for Mouse Cervical Heterotopic Heart Transplantation Model

一种改进的袖带技术用于小鼠颈椎异位心脏移植模型

Cardiac allograft rejection limits the long-term survival of patients after heart transplantation. A mouse heart transplantation model is ideal for ...